{
  "abstract": "BackgroundClinician-scientists translate clinical observation into discovery, trials, and policy, yet this workforce is shrinking across health systems worldwide. Integrated MB-PhD training, pausing medical training to complete a PhD before clinical exposure or specialisation, is one route into this career. We aimed to evaluate the long-term value of MB-PhD training and the barriers to clinical-academic careers faced after graduation.\n\nMethodsWe evaluated all 131 graduates (29.8% female) who entered the University College London (UCL) MB-PhD programme over a 25-year period (1994-2018). Bibliometric outputs were collated via an inter-linked information system. Concurrently, all 131 graduates were invited to respond to open-ended questions on career benefits and structural barriers; 99 (75.6%) responded, and responses were independently coded into themes, which were then reviewed and confirmed by a Study Group of 107 individuals, including the 91 respondents who agreed to participate further.\n\nResultsGraduates produced 5,877 publications (1,141 first-author, 819 corresponding-author), attracting 350,754 citations, with a mean relative citation ratio of 3.30 {+/-} 0.47, approximately three times the field average and sustained across three decades of programme entry. Graduates secured an estimated $157.55 million across 99 grants, released 465 public datasets, and were named investigators on 31 clinical trials across five continents. Among the 99 survey respondents, 49.5% held consultant-grade posts, 72.7% remained research-active, and 25.3% had reached senior academic grade. Openended responses were coded into five recurring structural barriers, subsequently confirmed by the Study Group: insufficient protected research time (72.2% of responses), unsupportive training structures and limited career opportunities (36.7%, 24.4% of responses), funding and pay barriers (22.2% of responses), and lack of mentorship or geographical/family constraints (14.4%, 13.3% of responses).\n\nConclusionsIntegrated MB-PhD training generates sustained academic productivity and leadership, but structural barriers threaten retention of graduates within clinical-academic careers. Protecting research time, stabilising funding and pay, and reducing geographic instability, amongst other interventions, are needed to retain the clinician-scientists that health systems have already invested in training.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Immunity and Transplantation, University College London, London, UK"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "D. J. Jafree"
    },
    {
      "name": "M. Sun"
    },
    {
      "name": "G. W. Stewart"
    },
    {
      "name": "F. Gishen"
    },
    {
      "name": "C. Swanton"
    },
    {
      "affs": [
        0
      ],
      "name": "R. Motallebzadeh"
    },
    {
      "name": "UCL MB-PhD Outcomes Study Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2jx5ra1kb3njt.bib",
  "cited_by": 1,
  "doi": "10.64898/2026.08.26.26361003",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361003v1.full",
  "id": "2jx5ra1kb3njt",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361003v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health policy"
    ],
    [
      "openalex",
      "2739|Health and Medical Research Impacts"
    ]
  ],
  "openalex": "W7204784325",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361003v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-26",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/2jx5ra1kb3njt.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:24Z",
      "native_id": "10.64898/2026.08.26.26361003",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361003v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health policy",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Integrated MB-PhD training is a long-term investment in the clinician-scientist workforce",
  "title_text": "Integrated MB-PhD training is a long-term investment in the clinician-scientist workforce",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:41Z",
  "url": "https://research.draconitic.com/paper/2jx5ra1kb3njt",
  "venue": "medRxiv",
  "versions": []
}